Category: Health Care Reform

America’s health care system is undergoing many changes – it’s hard for insurance professionals to keep updated let alone consumers. Here we make it easy and publish daily articles on the changes and challenges that health care reform has ahead.

Many health insurance denials in Pennsylvania to undergo fresh review

G. Turner
Health insurance - Denied - Pennsylvania

A new program in the state will focus on cases in which individuals have failed to obtain payments. The new Independent External Review program in Pennsylvania will be taking another look at health insurance claims in which policyholders felt they were incorrectly denied. Many people feel that the current appeal process hasn’t worked for them due to its limitations. There is already an appeal process available to health insurance customers whose claims have been denied for the cost of a medication or medical procedure. They have been able to appeal…

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Record numbers of Texas residents enrolled in ACA health insurance plans this year

Logan B.
Health insurance plans - ACA enrollment Texas

The state’s total enrollment numbers were recently released, with over 1 in 9 Texans covered. The 2024 open enrollment period came with a record number of Texan sign-ups for health insurance plans through the Affordable Care Act (ACA). The data was released by the federal government as the state uses the federal HealthCare.gov marketplace. Over 1 in every 9 residents of the state are now covered by health insurance plans sold through the ACA in 2024. This is a notable record, as it was set in the state with the…

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Consumers that missed the health insurance open enrollment have options

Logan B.
Health insurance - Investigating Options

There are definite financial risks from missing open enrollment, but all is not lost. The 2024 open enrollment periods for Affordable Care Act health insurance markets have now passed, and many consumers are now wondering what happens if they wanted coverage but didn’t obtain it in time. Understanding options begins with knowing what the open enrollment period is all about. The open enrollment period for buying health insurance allows people to purchase their coverage for the next twelve months. Many people already have coverage through work benefits and don’t need…

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New Jersey governor signs health insurance legislation expanding coverage

Logan B.
Health insurance - Infertility Coverage - New Jersey

Governor Murphy signed A5235/S3627 to expand coverage to include infertility services. New Jersey Governor Phil Murphy recently signed A5235/S3627 to expand requirements for health insurance coverage in the state to include infertility services. The legislation requires that many plans provide benefits relating to pregnancy healthcare services. The health insurance coverage requirements apply to certain private sector health insurance companies, including those under state regulation. They must now provide group plans with more than 50 people with pregnancy-related benefits. This also applies to plans in the School Employees’ Health Benefits Program…

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Health insurance plans frequently deny new weight loss medication claims

H. Cutner
Health Insurance declined - weight loss medication

Patients are finding that the drugs they were hoping would help them fight obesity might not be an option. Obesity patients prescribed new weight loss medications are discovering that the drugs they were counting on to help them to reduce their BMI often aren’t covered by their health insurance plans. Medications such as Wegovy have been making headlines since they received FDA approval. Many obesity patients who were desperate for a new option to try to treat their disease were thrilled when they heard that there were new medications available.…

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